A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be “bad.” Which defense was the client using when this statement was made?

Splitting

Ambivalence

Passive aggression

Reaction formation

Answer and Explanation

The Correct Answer is A

Splitting is a primitive defense mechanism commonly seen in individuals with borderline personality disorder (BPD). It involves an inability to integrate positive and negative aspects of oneself or others into a cohesive whole. As a result, people are viewed as either entirely good or entirely bad, with no middle ground. This black-and-white thinking often leads to unstable relationships, emotional lability, and frequent shifts in idealization and devaluation. Splitting serves as a way to manage intense anxiety and fear of abandonment by simplifying complex emotional experiences.

Rationale for correct answer

A. The client’s statement that others are all “bad” demonstrates polarization, which defines splitting. This mechanism allows the individual to cope with conflicting feelings by categorizing people or experiences as all good or all bad. In BPD, this arises from difficulty tolerating ambivalence, resulting in unstable interpersonal relationships and intense emotional reactions.

Rationale for incorrect answers

B. Ambivalence refers to simultaneous opposing emotions toward the same person or situation. It reflects emotional conflict but not the rigid separation of good and bad qualities characteristic of splitting.

C. Passive aggression involves indirect expression of hostility, such as procrastination or resistance, rather than overtly labeling others as bad. It is a behavioral response, not a cognitive distortion like splitting.

D. Reaction formation occurs when an individual behaves in a way opposite to their true feelings, such as expressing affection toward someone they actually dislike. This differs from splitting, where individuals categorize people into extremes without emotional reversal.

Take Home Points

Splitting is a hallmark defense mechanism in borderline personality disorder.
It reflects an inability to integrate both positive and negative perceptions of self or others.
This defense contributes to unstable relationships and intense emotional shifts.
Treatment focuses on helping clients recognize and integrate conflicting feelings for healthier emotional regulation.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is C

Explanation

Antisocial personality disorder (ASPD) is characterized by a pervasive pattern of disregard for and violation of the rights of others, impulsivity, and lack of remorse. Individuals often manipulate, deceive, or exploit others for personal gain. They frequently ignore rules, show little empathy, and fail to learn from negative experiences. Nursing management focuses on establishing structure and consistent boundaries, as these clients respect authority only when clear consequences are enforced.

Rationale for correct answer

C. Providing clear boundaries and consequences is the most important intervention for clients with antisocial personality disorder. This approach ensures safety and prevents manipulation by maintaining structure and predictability. Firm limit-setting helps the client recognize that behaviors have consequences and that privileges are earned through acceptable conduct. Consistency among staff is essential to prevent manipulation and maintain therapeutic control.

Rationale for incorrect answers

A. Teaching and role-modeling assertiveness are appropriate for clients who lack confidence or have difficulty expressing needs, such as those with dependent or avoidant disorders, not for manipulative antisocial clients.

B. Using a gentle and reassuring approach can be misinterpreted as weakness, encouraging manipulation or exploitation. Clients with ASPD often test limits and may take advantage of overly permissive staff.

D. A democratic and overly empathetic style is not effective with antisocial clients. These individuals require firm, direct communication and consistent enforcement of rules rather than negotiation or shared decision-making, which they may manipulate.

Take Home Points

Antisocial personality disorder requires firm boundaries and consistent consequences to reduce manipulation.
A structured environment promotes safety and accountability.
Overly gentle or permissive approaches increase the risk of exploitation.
Consistency among staff prevents manipulation and reinforces behavioral control.

A. Hold the client by the arm to prevent leaving the group. B. Instruct the client with a loud voice to get in the bus so the group can go home. C. Inform the client in a matter-of-fact tone that everyone must remain with the group. D. Tell the client that the baseball player will not be permitted to give anyone an autograph.

Correct Answer is C

Explanation

Narcissistic personality disorder (NPD) is marked by an exaggerated sense of self-importance, an excessive need for admiration, and a lack of empathy for others. Individuals with NPD often believe that normal rules or expectations do not apply to them and may act entitled or superior. They seek attention and recognition to maintain their inflated self-image. Nursing management focuses on setting firm, consistent limits while maintaining a calm, professional, and non-confrontational approach to prevent escalation or humiliation, which these clients cannot tolerate.

Rationale for correct answer

C. Informing the client in a matter-of-fact tone that everyone must stay with the group establishes clear boundaries without confrontation. This approach reinforces rules consistently while minimizing attention to the client’s attention-seeking behavior. It models respectful authority, maintains group safety, and reduces the likelihood of power struggles, which could reinforce the client’s need for control or superiority.

Rationale for incorrect answers

A. Physically restraining the client without cause is inappropriate unless there is immediate danger. This action could provoke anger, increase resistance, and damage trust, escalating the situation unnecessarily.

B. Using a loud or authoritative tone draws attention to the client, reinforcing their need for admiration and control. It can also embarrass or provoke the client, leading to defiance or aggression.

D. Telling the client the player will not give autographs introduces unnecessary information and may lead to argument or denial. It also fails to address the behavioral issue—following group expectations and respecting boundaries.

Take Home Points

Clients with narcissistic personality disorder require firm, consistent, and calm limit setting.
Avoid emotional or confrontational responses that feed attention-seeking behaviors.
Matter-of-fact communication maintains boundaries while preserving dignity and safety.
The goal is to promote compliance with rules without reinforcing entitlement or superiority.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be “bad.” Which defense was the client using when this statement was made?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which nursing intervention is most important for a client who has the diagnosis of antisocial personality disorder?

Correct Answer is C

Explanation

The clients on a mental health unit go on a supervised day trip to a baseball game. When returning to the bus, a client with a narcissistic personality disorder insists on leaving the group to get an autograph from a player. What is the most appropriate response by the nurse?

Correct Answer is C

Explanation

A nursing student is learning about narcissistic personality disorder. Which student statement indicates that learning has occurred?

A patient becomes frustrated and angry when trying to get his MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which intervention(s) would be the most therapeutic? Select all that apply.

A client diagnosed with a borderline personality disorder is given a nursing diagnosis of disturbed personal identity related to unmet dependency needs as evidenced by the inability to be alone. Which nursing intervention would be appropriate?

A 15-year-old client living in a residential facility has a nursing diagnosis of ineffective coping related to abuse as evidenced by defiant responses to adult rules. Which of the following interventions would address this nursing diagnosis appropriately? Select all that apply.

A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be “bad.” Which defense was the client using when this statement was made?

After being treated in the ED for self-inflicted lacerations to the wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority?

A client diagnosed with an antisocial personality disorder is given a nursing diagnosis of self-esteem disturbance related to extreme poverty as evidenced by continual boasting and grandiosity. Which nursing intervention would be appropriate?

A client with a personality disorder tells a nurse, “I want to tell you something, but you must promise to keep it a secret.” Which response could lead to splitting among the staff?